Healthcare Provider Details

I. General information

NPI: 1942364898
Provider Name (Legal Business Name): UPMC MCKEESPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 11/27/2023
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 5TH AVE
MCKEESPORT PA
15132-2422
US

IV. Provider business mailing address

600 GRANT STREET, US STEEL TOWER, 59TH FLOOR C/O RENEE JOHNSON
PITTSBURGH PA
15219-2740
US

V. Phone/Fax

Practice location:
  • Phone: 412-432-5500
  • Fax:
Mailing address:
  • Phone: 412-623-6303
  • Fax: 412-623-6369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1007643400026
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerION HEALTHCARE NUMBER
# 2
Identifier0008
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK PROVIDER NUMBER
# 3
Identifier000000056049
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMEDPLUS NUMBER
# 4
Identifier1007643400014
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: LAURENE TIMMONS
Title or Position: CFO
Credential:
Phone: 412-664-6781